We’ve been hearing for months that Republican elected officials wanted to “repeal and replace Obamacare” — officially known as the Affordable Care Act — as soon as they got into office. But efforts to do so have met with resistance both inside and outside of Congress. The saga has seen many twists and turns — but where does it stand now?
That’s the million-dollar question on every Congress-watcher’s mind in D.C. these days.
How Did We Get Here?
Getting the House to pass its version of the bill was rocky enough. At first, its very existence was a mystery that even members of Congress couldn’t solve. Then, a few weeks later, a vote on the measure was abruptly cancelled minutes before it was scheduled to happen when it became clear that the votes weren’t there.
The Senate’s version has had less high comedy and fewer cartoon-style chase scenes, but has been every inch as thorny a process for its supporters.
Its process, too, was largely conducted in secret, leaving everyone else to piece it together from leaks and educated guesses. Eventually, a version became public. Here’s a timeline of what’s happened since then:
June 22: Senate finally released draft bill of its plan to repeal and replace the Affordable Care Act.
June 23: After getting a look at the text, hospital, doctor, and public health groups nationwide oppose the bill, saying it makes “unsistainable” cuts to coverage.
June 26: The Congressional Budget Office (CBO) comes up with a preliminary score, finding that the bill would likely cause 22 million more Americans to become uninsured than currently are.
June 27: Unable to come to consensus before the July 4 recess, the Senate postpones the vote on the bill until July.
Where The Senate Stands
Republicans are not currently including Democrats in their effort to craft a bill, so anything they do come up with will have to pass on a party-line vote. That means it needs at least 50 senators in favor, with Vice President Mike Pence added in as a tie-breaker; right now, that count stands at maybe 43, give or take.
FiveThirtyEight, in its most recent estimate, figures that right now there are seven Republicans unwilling to move forward on the current bill.
In Congress, a party’s majority leader sets the agenda and wrangles their colleagues into shape to create and vote for a bill. When it comes to the healthcare bill, however, Senate Majority Leader Mitch McConnell (KY) has before him the difficult task of reconciling two opposed factions within the Republican party.
One faction is led by Sen. Ted Cruz (TX), joined by Sens. Ron Johnson (WI), Mike Lee (UT), and Rand Paul (KY).
The Cruz contingent believes, basically, that the bill as proposed is not conservative enough.
Cruz has proposed an amendment that would allow states to permit insurers to sell plans that do not cover essential health benefits and that can exclude some persons with pre-existing conditions, so long as those insurers also sell at least one plan that does meet current standards. If that amendment becomes a part of the bill, it’s likely that this group of Senators would support it.
But then there’s another faction: Call it the moderates. That group right now is Sens. Dean Heller (NV), Susan Collins (ME), Shelley Moore Capito (WV), and Rob Portman (OH).
They’re not quite as unified as their hardcore conservative peers, but each has a related objection to the bill that exists. Collins and Heller both have voiced strong concerns about the changes to Medicaid that would result in lost coverage.
Capito and Portman have also both said they think the proposal cuts Medicaid too deeply, and Capito has also said she’s concerned about coverage for people with a pre-existing condition.
So Now What?
The Senate was supposed to come back after the July 4 recess and sit down and agree to something they could vote on. D.C. insiders and Congressional reporters say that process, so far, is a mixed bag.
McConnell announced today that the Senate will stay in session through the first two weeks of August. Usually, Congress leaves town for the entire month, and that time has been scheduled off this year as well.
Shifting the break strongly implies that McConnell feels he needs more time to wrangle his party’s members into shape and make a bill happen. However, CNN’s Manu Raju reported today that McConnell plans for a new draft to be released this Thursday (July 13), with a new CBO score predicted to follow the week of July 17 and a vote on a motion to proceed shortly thereafter.
Reports remain contradictory about McConnell’s likelihood of success, though. Axios reports today that the next version of the bill is likely to retain its deep Medicaid cuts, a move that will please conservatives but alienate the moderates.
But at the same time, CNN reports that conservatives feel they are “losing” in negotiations, and that the final bill will not be one they can support.
On top of all that, Politico reports, Sen. Lindsey Graham (SC) has announced he’s working with other senators to draft a completely different healthcare overhaul bill — and he’s aiming for bipartisan support.